Adolescent Health

Patterns and
Programmes

Focuses on vulnerabilities associated

with adolescents and interventions
proposed to promote their health and
well-being
Learning Objectives

By the end of this session, residents will be able to:

• Discuss the disease burden among adolescents

• Describe global strategies for adolescent health
• Discuss ethical issues in the care of adolescents
Agenda

• Let's get thinking

• Disease burden among adolescents

• Global strategy for adolescent health

• Adolescent policies and programmes in Ghana

• Ethical issues in the care of adolescents

Let’s get thinking…

What makes adolescents

unique?
Who is an Adolescent?

• An adolescent is an individual between the ages of 10 to 19 years.

• It is a unique stage of human development and an important time for
laying the foundations of good health.

• Early adolescence is the period between age 10 to 14.

• Late adolescence is the period from 15 to 19 years.
• Adolescent programmes may involve young adults between ages of 20
to 24 years.
Adolescent Population

• Young people account for 42% of the global population.

• Around 1.2 billion of these young people are adolescents between 10

and 19 years old.

• In Ghana, adolescents constitute 21.9% of the population

• Adolescents face many health challenges and gender-based violence

• Adolescent health and development are key foundations for a country’s

economic development and stability.
Discussion

Adolescents
are healthy

True False
Discussion – cont’d

• It is often assumed that adolescents are healthy.

• Gains from investments in maternal and child health programmes are not
sustained in adolescence

• Reduction in child mortality does not mirror a similar reduction in

adolescent deaths.
Gender disparities

• Health risks become increasingly skewed along gender lines during

adolescence.

Why is this the case?

(WHO, 2023a)
Gender disparities – cont’d

• Violence is one of the biggest threats

that young people face.

• In 2022, approximately one billion

children and adolescents worldwide
experienced emotional, physical, or
sexual violence.

• One in five girls under the age of 20

report experiencing sexual violence,
compared to 8% of boys.

• Girls are more likely to experience

sexual or physical violence.
Gender disparities – cont’d

• Boys are more likely to be victims or

perpetrators of homicide.

• Homicide is among the top five

causes of death in adolescents, and
males comprise over 80% of victims
and perpetrators.

• Boys are also more likely to be in road

traffic accidents.

• Social and economic inequalities

always have a detrimental effect on
health
(WHO, 2023a)
Gender disparities – cont’d

• Adolescents from ethnic minorities,

refugees, young offenders etc may face
greater health challenges

• Attitudes to menstruation in some

communities can lead to the
ostracization of girls from educational or
social activities with lifelong
repercussions

• Stigma and discrimination may deny girls

access to fact-based sexuality
education.
 Adolescent Policies
and Programmes

Initiatives to promote the health and well-being of Adolescents

The Global Strategy (2016 – 2030)

• Adolescent health is starting to attract the attention it deserves and is

increasingly prominent in global health initiatives.
• This includes the Global Strategy for Women’s, Children’s and
Adolescents’ Health (2016-2030).
• It also provides a roadmap for ending preventable deaths of women,
children and adolescents by 2030.
• The strategy will help adolescents achieve their potential for and rights to
health and well-being in all settings.
The Global Strategy (2016 – 2030) – cont’d

Objectives
• Survive: end preventable deaths
• Thrive: ensure health and well-being
• Transform: expand enabling environments

These objectives are aligned with some of the Sustainable

Development Goals (SDGs)
The Global Strategy (2016 – 2030) – cont’d

• The strategy was developed through evidence reviews, syntheses and

global stakeholder consultation.
• Draws on new thinking about priorities and approaches for health and
sustainable development.
• It seeks transformative change across numerous challenging areas for
health and sustainable development
• It is the product of the successes and challenges of the countries in
implementing the previous Global strategies and MDGs

(Kuruvilla ae al.,, 2016)

Facilitators of the Global Strategy
AA-HA! Initiative

• In 2017, WHO UNICEF, UNAIDS and UNFPA launched a major initiative

called Accelerated Action for the Health of Adolescents (AA-HA!) to
change the way countries tackle adolescent health.

• The AA-HA! guidance calls for a systematic inclusion of adolescents’

expectations and perspectives in health planning processes.
AA-HA! initiative – cont’d

• AA-HA! provides:

• current evidence-based data on adolescent health

• practical solutions to address challenges

• Health is made at home through direct or indirect interventions.

• The AA-HA! guidance therefore sets out a broad approach

Health and Wellbeing
of Adolescents
Wellbeing of Adolescents

● A call to redesign adolescent health programming into a comprehensive

health agenda, with consideration of the following guiding principles:

○ a life-course approach, with attention to the broader determinants of

adolescent health and well-being

○ translation of child rights into equitable laws and policies

○ universal access to evidence-based services, with particular attention
to the most vulnerable and disadvantaged
Wellbeing of adolescents – cont’d

• Meaningful participation of adolescents and families

• Respectful adolescent and family-centred care that is gender-

responsive

• Whole-of-Government and whole-of-society engagement

Gender disparities
To survive and thrive, children and
adolescents need:
• Good Health
• Adequate Nutrition
• Security, Safety, a Supportive,
Clean Environment
• Opportunities for early learning
and education
• Responsive relationships and
connectedness
• Opportunities for personal
autonomy and self-realization
Adolescent Well-Care Visits

Well-care visits are scheduled routine, regular checkups by

health-care providers to ensure the healthy growth,
development and well-being of adolescents in the first two
decades of their lives and to support and guide parents in the
care they give to their adolescents and themselves.
Discussion
● You have 5 mins to work in your small groups

● Discuss what an adolescent well-care visits would look like in your practice?

● What measures would you put in place to make it gender-responsive?

● You have two minutes to share with the larger group

Adolescent Well-Care Access
School health
services

Telehealth and virtual Primary healthcare

communication facilities
platforms

Community based Early child

services development centres
Adolescent Well-Care Visit Activities
Elicitation of Parental
and Adolescent
Concerns
Anticipatory Psychosocial and
Guidance Environmental
Assessment

Counselling and Comprehensive

Delivery of Physical
Relevant Examination
Interventions

Screening Physical Growth

/Checking for and Development
relevant Conditions Monitoring
(WHO, 2023b)
Benefits of Well-Care Visits

• Promote health and healthy behaviour

• Observe the progress of adolescents
• Disease prevention and guidance
• Identify health risks, delays and disabilities
• Identify and address the needs of adolescents and caregivers

(WHO, 2021)
What adolescent programmes exist
in the facility or community where
you work?
Adolescent Policies & Programmes in Ghana

• The International Conference on Population and Development (ICPD)

1994 landmark conference in Cairo, transformed global thinking on
population and development issues.

• ICPD set the standard for people-centred development, guiding national

policies and programmes.

• The Ghana government along with 178 other governments adopted the
ICPD Programme of Action.
Adolescent Policies & Programmes in Ghana – cont’d

• Adolescent Reproductive Health Policy (2000)

• Children and Youth Ambassadors for WASH in Ghana (2013)
• Adolescent Health Service Policy and Strategy (2016 - 2020)
• Five Year Strategic Plan To Address Adolescent Pregnancy In Ghana (2018 –
2022)
• Ghana Reproductive, Maternal, Newborn, Child and Adolescent Health and
Nutrition (RMNCAH&N) Strategic Plan (2020 - 2025)
• National Operational Guidelines and Standards for adolescent and Youth-
Friendly Health Services (2018)
• Adolescent Health Ambassadors Network​ (2019)
• Digital Health platforms
Ethical Considerations
What are some of the ethical principles that
guide our practice as nurses and midwives?
 Ethical Principles in Nursing

• Ethical principles are rules, standards or guidelines from different moral

theories that guide our actions about what is good for humans.

• They reflect philosophical cultural, religious and societal beliefs about

what is valuable.

• They may vary from one society to the other.

(Beauchamp & Childress, 2019; Grace & Uveges, 2022)

Ethical Principles in Nursing – cont’d

The following principles have remained prominent in healthcare globally:

• Respect for autonomy: self-determination

• Beneficence: do good

• Nonmaleficence: do no harm

• Justice: fairness

(Beauchamp & Childress, 2019; Grace & Uveges, 2022)

Other Ethical Considerations in Nursing

Fidelity Veracity Accountability

 Autonomy in the Care of Adolescents

• Autonomy is on the assumption that all persons have intrinsic and

unconditional worth and have the power to make rational decisions and
moral choices and should be allowed to exercise his or her capacity for
self-determination.

• Informed consent, truth-telling, and confidentiality spring from the

principle of autonomy.

(Varkey, 2021)
Informed Consent

A documented (usually written) agreement or permission

accompanied by full and clear information on the nature, risks
and alternatives of a medical procedure or treatment or
intervention and their implications before the physician or other
health care professional begins the procedure or treatment or
intervention.

The age of consent in Ghana is 18 years

(GHS, 2018)
Assent

Refers to children’s and adolescents’ participation in decision-

making on health care and research interventions by voluntarily
giving an approval. In all cases, whether or not the consent of the
parent/guardian is required, the voluntary, adequately informed,
non-coerced and non-rushed assent of the adolescent or child
should be obtained.

(GHS, 2018)
Informed Consent/Assent – cont’d

An adolescent can either consent to or refuse the procedure, treatment

or intervention.

The procedure, treatment and interventions requiring informed consent

are stipulated in laws and regulations of the country.

Many procedures, treatments and interventions do not require informed

consent.

However, they all require that the adolescent is supported to make an

informed choice and give assent if so desired
(GHS, 2018)
Informed Consent/Assent – cont’d

What are some of the

procedures in your
practice that do not
require informed consent?

What are some of the

procedures in your
practice that require
informed consent?
Informed Consent/Assent – cont’d

• Informed consent and assent are issues that the health facility should
respect and observe as and when required
• Unless the decision-making capacity is delegated by law to a third
party, or the adolescent lacks decision-making capacity as assessed
by the relevant authority
• The adolescent decides about all aspects of care, including refusing
care.

(GHS, 2018)
Informed Consent/Assent – cont’d

• The Adolescent decides which family members and friends, if any,

participate with them in the care process.

• Adolescents’ involvement in care is respected irrespective of whether

the adolescent has a legal capacity for decision-making.

• An Adult’s judgement cannot override the obligation to respect all

rights of the adolescent as stipulated in the Convention of the Rights
of the Child.

(GHS, 2018)
Evolving Capacities

An adolescent who is capable of forming her/his own views

has the right to express those views freely in all matters
affecting her/him, and have those views given due weight
per age and maturity
Privacy and Confidentiality

• Confidentiality – the right of an

individual to privacy of personal
information, including health care
records.
• Confidentiality governs:
• How data and information are
gathered e.g. a private consulting
room
• How the data are stored e.g. using
codes and other identifiers instead
of names)
• How the data and information are
shared.
Privacy and Confidentiality – cont’d

Healthcare providers should not disclose any information

given to or received from the adolescent, to third parties
such as parents, teachers, friends, relatives and/or
employers without the adolescent’s unequivocal consent,
Discussion

How would you incorporate family centred care without

compromising confidentiality?
Case Scenario 1

A 17-year-old, Debby visited your unit for family planning services. She
returns to the family planning clinic in the company of her father next
day. He demands to know from you what his daughter came to the
clinic to do the previous day.

What would you do?

Case Scenario 1 – cont’d

Debby feels upset by her father’s action and blurts out in tears telling
him she had an implant inserted because she did not want to get
pregnant. Her father becomes more furious and orders you to take out
the implant immediately so he can take her to his religious leader for
deliverance.

How would you handle this situation considering FCC

and SBN in your approach?
Take Home Messages

• Investments in adolescent health offers us “Triple dividend of benefits”​

• Today​
• For decades to come​
• The next generation.​
• Healthcare providers should support and promote adolescent
involvement in all aspects of care
Debrief

• What was most valuable to you in this session?

• What did you enjoy the most?

• What would you have liked to cover that was not?

 References
Beauchamp, T., & Childress, J. (2019). Principles of biomedical ethics:
marking its fortieth anniversary. The American Journal of Bioethics, 19(11),
9-12.
Ghana Health Service (2018). National Operational Guidelines and
Standards for Adolescent and Youth-friendly Services .
Ghana Health service (n.d.) Adolescent Health Training Manual for
Healthcare Providers.
Grace, P. J., & Uveges, M. K. (2022). Nursing ethics and professional
responsibility in advanced practice. Jones & Bartlett Learning.
Kuruvilla, S., Bustreo, F., Kuo, T., Mishra, C. K., Taylor, K., Fogstad, H., ... &
Costello, A. (2016). The Global strategy for women’s, children’s and
adolescents’ health (2016–2030): a roadmap based on evidence and
country experience. Bulletin of the World Health Organization, 94(5), 398.
 References
Varkey, B. (2021). Principles of clinical ethics and their application to
practice. Medical Principles and Practice, 30(1), 17-28.
World Health Organization (2023a) Coming of age: adolescent health.
Retrieved from: https://www.who.int/news-room/spotlight/coming-of-
age-adolescent-health
World Health Organization (2023b) Improving the health and wellbeing of
children and adolescents: guidance on scheduled child and adolescent
well-care visits. Retrieved from:
https://iris.who.int/bitstream/handle/10665/376159/9789240085336-
eng.pdf?sequence=1
World Health Organization, UNICEF (2021). Investing in our future: a
comprehensive agenda for the health and well-being of children and
adolescents. Geneva: World Health Organization. https://www.who.int/
publications/i/item/9789240037793